MENZ Issues February 1999: Volume 4 Issue 1

Commissioner’s Call to Remove Children The Commissioner for Children, Roger McClay, is reported to have said that parents and child-care workers should have the children taken away from them immediately after the first complaint of sexual abuse has been made.

Reduced Health Funding For Men? The Women’s Health Policy National Consultation suggests that women need more resources because "they live longer and they are more frequent users of health services." We thought these were reasons why men should receive more attention!

Diet and Prostate Cancer While it is accepted that diet plays a role in the incidence of prostate cancer, the details are still unclear, although recent studies have developed some promising leads.

Tauranga Doctors Pioneer New Surgery Technique Urologists Dr Mark Fraundorfer, Dr Peter Gilling and Dr Michael Cresswell have received approval from the USA Food and Drug Administration for their "holmium laser resection" of the prostate.

On the TURPs Most common problems in men’s waterworks are not cancer at all – merely enlarged prostate tissue obstructing flow. I have been personally researching the operation commonly called a ‘ream-out’ or ‘rebore’. The proper name for this operation is trans-urethral resection of the prostate – normally abbreviated so that my talk this evening is called ‘On the TURPs’.

Health Promotion or Radfem Propaganda? The August 98 publication from Auckland Healthcare Services Ltd says "it is estimated that 95% of partner violence is committed by men." Clearly you have to be very selective about the data you consider if you want to make these kind of ideologically inspired ‘estimates’. This kind of deliberate dissemination of misinformation does not exactly inspire confidence in the credibility of this organisation.

Depression special challenge for men While there are perhaps three options for "respite" or time for severely depressed sufferers, none of these are regarded as ideal by advisers. And there is no centre where those suffering from depression could go during the day – a kind of community house where feelings and experiences could be shared with others suffering the same. That would be a valuable asset, especially for men who are left out on a limb by their natural isolation….and masculine hang ups over talking about their depressive episodes.

The State of Men’s Health I agree with Men’s Centre chairman Mark Rowley that simply insisting that men be less masculine would change little and achieve less. Blaming men for their health problems only marginalise male heath issues. Men have allowed society to stereotype them into roles that are not consistent with good health care practices. We teach men to deny they are ill, which conforms to the traditional macho view of men. This stops men from accessing primary care, and they thus become excluded from it.

Commissioner’s Call to Remove Children

On 11th Nov 98 The Dominion carried an article headlined: ‘Commissioner calls for rapid response to sex abuse alarm’. The Commissioner for Children, Roger McClay, is reported to have said that parents and child-care workers should have the children taken away from them immediately after the first complaint of sexual abuse has been made. He says he is "rapidly developing" a view that if in doubt you should "favour the children" by removing them "instantly".

He was planning to meet with the Children, Young Persons and their Families Service to discuss this proposal. We understand that they are about to be radically ‘downsized’, except for the Child Protection workers. No doubt the prospect of expanding the market will sound like music to some soon-to-be-redundant ears.

Mr McClay seems to have accepted the radical feminist slogans that "women and children never lie about abuse", and that professionals should always "believe the children". Unreasonable doubt has become reasonable in the panic over child safety. The criteria defining ‘reasonable’ has shifted in defiance of common sense.

Data from the Christchurch Health and Development Study indicates that incest by New Zealand fathers – at a rate of two per thousand children – is fairly rare. Furthermore, a significant number of sexual abuse allegations have been shown to be false, particularly when fathers are accused in disputed custody/access situations. Children who do not live with their biological father are at significantly higher risk of abuse, from stepfathers, or worse, a series of casual boyfriends. Perhaps the highest risk of all is when children are placed in foster care, where they are forced to encounter other children with major psychological and behavioural problems.

The danger of unwarranted panics occurring in childcare centres when over-zealous investigators leap to conclusions has also been extensively documented in recent years.

McClay’s statement stands in stark contrast to that made recently by psychiatrist Karen Zelas, as reported in the November MENZ Issues (here). She now cautions about the long-term negative psychological effects that can result frofrom removing a parent or disrupting a family on the basis of an unsubstantiated abuse allegation. She warns that such an intervention should not be undertaken lightly, and should only happen in circumstances where there is significant evidence of abuse. The interests of children are not served by policies based on out-of-date radical feminist dogma. I don’t doubt that Mr McClay is well-intentioned, but as American author Susan Sarnoff (an Assistant Professor of Social Work at Ohio University) points out: "Meaning well is not doing good".

The Commissioner should have a hard look at the people who are advising him; perhaps a father or three on his staff would help prevent this kind of unnecessary faux pas.

In Jan 1996, North Health issued a discussion document called "The Health of Men" saying: "Our impression is that thinking about women’s health is more advanced than that of men." We agree with them wholeheartedly – consider that in the mid 1990’s males made up:

94% of workplace deaths

84% of workplace injuries

82% of pneumonia & influenza deaths

82% of bronchitis, emphysema and asthma deaths

80% of suicide deaths

70% of coronary heart disease deaths 64% of cancer deaths

The life expectancy gap has increased to over 6 years for women – from only 2 at the beginning of the century.

So what are professional health activists up to these days? Recently, we received an information kit for a ‘Women’s Health Policy National Consultation’, put together by Teenah Handiside, national co-ordinator of the Federation of Women’s Health Councils – Aotearoa New Zealand. It is intended to be used by women who want to contribute to the development of a National Women’s Health Policy. In the first section it attempts to justify why women deserve a larger slice of the health funding pie.

It begins: "To some extent men, women and children want the same out of the health system: an accessible, affordable service that meets their health needs. Women, however do have some different needs to men – not just in terms of maternity and other gynaecological services, breast cancers etc. – but also in terms of their different lives."

These supposedly ‘different lives’ include such factors as:

poverty – women are more likely to be unemployed, or on a welfare benefit,

they aren’t as likely to have health insurance,

only they suffer from domestic violence (presumably the authors get their information from the same source as the Health Promotion newsletter, reviewed on page 4),

social attitudes which render them and their health concerns invisible (the publications targeting doctors that arrive in our household typically have ten items on women’s health for every one on men’s),

they have a double work load!

It goes on to suggest that women need more resources because "they live longer and they are more frequent users of health services." And we thought these were reasons why men should receive more attention! The kit claims that women "have lower than average incomes and can afford to pay less for their health services", which ignores the fact that there are large numbers of unemployed or sick men who aren’t able to earn above average wages.

Also, "Many women want to be able to choose whether to access the ‘medical model’ or something different; women are high users of alternative therapies." The kit doesn’t make clear which ‘alternative therapies’ they consider should receive funding.

The kit points to the need for increased services to address "diseases which are becoming more prevalent in women, for example mortality from lung cancer, HIV/AIDS and substance abuse." In stark contrast, discussion of lifestyle induced illness in men inevitably concentrates on changing the men rather than the health delivery system.

The kit claims that evaluation of the Australian National Women’s Health Policy found that it was easier to set up separate women’s services than to influence the mainstream. After all, as the final page reminds us "It is essential to remember that the practice of medicine and the modern health system were developed without the involvement of women. Therefore women’s experience was not included in medicine and the health knowledge base."

Buried deep inside the document, the Federation reveals its true agenda. They advocate "policy development which neutralises the impacts of current economic, patriarchal, geopolitical/demographic and scientific interests."

One wonders just what sort of society these radfems have in mind. I can’t help but recall Camille Paglia’s statement that "if we left technological advancement up to women we would still be living in grass huts." I believe that improving women’s health would be best be served by directing resources towards real services, and education about issues such as smoking, Foetal Alcohol Syndrome, and diet rather than trying to overthrow the patriarchy.

We are also reminded that our government needs to meet its international obligations, and that CEDAW requires that "States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care on a basis of equality of men and women." We have no problem with this – clearly health economists need to urgently find ways to quantify gender-specific health funding to ensure this requirement for equality is being met.

With the obvious exception of maternaty-related services, basic healthcare should be available on an equal basis to all New Zealanders in need, regardless of their gender.

J.P.

Diet and Prostate Cancer

While it is accepted that diet plays a role in the incidence of prostate cancer, the details are still unclear, although recent studies have developed some promising leads.

Research published in the Journal of the National Cancer Institute by Kazuko Yoshizawa and his colleagues shows that the risk of prostate cancer can be reduced by as much as two thirds by a diet high in selenium. This is obtained by eating meat, chicken, seafood, grains, broccoli, garlic, onions and brewer’s yeast.

However Morton et al, writing in the British Journal of Urology claim that a diet high in calories, animal fat and meat increases the risk. They suggest a protective effect can be obtained by eating foods high in carotene (pumpkin, carrots, lettuce, spinach and asparagus). Another study by H Gerster also showed that lycopene (tomatoes, watermelon, guava, and pink grapefruit) may give some protection.

The low incidence of prostate cancer among Chinese, Japanese and vegetarian men may be attributable to phytoestrogens in tofu and other soy products. The Australian drug company Novogen has just launched a diet pill called Trinovin made from New Zealand red clover. The plant is one of the world’s richest sources of hormones called isoflavones, also found in chickpeas, soy, lentils and some beans. Colin McRae, clinical director of urology at Auckland Hospital, is sceptical about dietary supplements, and suggested that trying to copy an Asian diet with a pill is simplistic.

Dr John Birkbeck, medical director of the Nutrition Foundation, said that while there is evidence that isoflavone-rich products are beneficial, experts do not yet know all the negative effects.

Heinonen et al report in the Journal of the National Cancer Institute that there is strong evidence that tocopherol (vitamin E) supplements (50mg/daily) can be of benefit. Smokers who received 50mg/day had a 36% lower incidence of prostate cancer compared to a control group. Most studies have failed to demonstrate that supplements of either vitamin A or beta carotene are of use.

A study of 46,000 Canadian men has shown that early detection of prostate cancer saves lives. The 8 year study, reported at the annual meeting of the American Society of Clinical Oncology, found that death from prostate cancer is 69% lower in men who undergo preventative screening. The researchers recommend that all men over 50 should have PSA (blood) tests and digital rectal examinations.

Urologists Dr Mark Fraundorfer, Dr Peter Gilling and Dr Michael Cresswell have received approval from the United States Food and Drug Administration for their "holmium laser resection" of the prostate. Standard laser surgery ‘cooks’ the prostate causing it to shrink over many weeks. The new technique removes tissue using electrical power, resulting in shorter hospital stays, reduced use of catheters, no blood transfusions and a quicker return to normal activity.

The Men’s Hour has already featured that peculiarly male organ the prostate gland. Cancer of the prostate kills 600 New Zealanders per year, but research on causes & treatments is negligible. This is the only fast-growing large category of cancer in New Zealand lately, and is already far more important than female genital cancers – cancer of the cervix has been fairly steady, killing about 90 per year. The cervical screening programme of Mss Bunkle, Cartwright & Coney, now reaching over 80% of the relevant women with a so-called early warning test which is of little or no use, actually causes indirect harm, but continues to spend $6M/y nation-wide – about $2M/y in the Auckland region. Meanwhile, a genuine early-warning test for cancer – of the prostate – gets a subsidy of $0.038M/y for the Auckland region, and even this paltry $38,000 has been threatened with decrease. The disparity of funding is one sure sign among many of injustice to men.

North Shore MP Ian Revell convened (late 1997) a public meeting on health. Several Men’s Centre members went along, and we asked a better class of question even if I do say so. Mr Revell turned out to know nothing much about prostate illnesses, but undertook to look into it for us. Which is more than was done by his unannounced sidekick Tuariki ‘John’ Delamere, associate minister of health but with nothing to say on this aspect of men’s health.

The Men’s Centre will be pursuing this important issue of prostate cancer. But most common problems in men’s waterworks are not cancer at all – merely enlarged prostate tissue obstructing flow. I have been personally researching the operation commonly called a ‘ream-out’ or ‘rebore’. The proper name for this operation is trans-urethral resection of the prostate – normally abbreviated so that my talk this evening is called ‘On the TURPs’.

Having now experienced an apparent rapid success followed by a very trying setback, and discussed with others their various experiences, my perspective on the TURPs is I hope of some use to those who may be contemplating this operation. My conclusion is that the best current version of the TURP is today rather highly refined. I urge that fear should not be a reason to defer your TURP if, on expert advice, you reach the conclusion that the best way forward for you and your prostate is to get on the TURP. What is perhaps less well known is that sometimes the operation achieves no benefit – no change in the hydraulics. It would seem to follow that, if your symptoms are not too severe, the operation may be sensibly deferred. Such decision cannot be properly reached without careful examination by several painless methods. If you have a severe problem in urinating, do not delay expert examination.

There are indeed several versions of this ream-out operation – thus the plural in my title. What I can be sure of is that the operation was painless. A typical period in hospital for the whole caper when it goes straightforwardly is 3 days but of course some will be unlucky and need longer, while some will be home within 24hrs after the operation.

You are vigorously urged to drink 2 – 3 litre/day straight after the op and indeed for a week or more afterwards. My urologist slapped me on a beer diet which he has overlooked to withdraw; but there is some expert opinion that beer contains something which irritates the bladder, so be prepared to experiment with, if not mix, your drinks.

My most urgent advice is to be aware of a little-mentioned emergency which can become serious within any hour during the recovery period. Fragments of tissue, or clots, can block the flow of urine. This constitutes the emergency of male urology: an acute retention – total blockage of urine flow – is an urgent threat to life and must be relieved promptly. If your bladder bursts into your abdomen it may well kill you. I am sorry to say that there are nurses who do not know this – "contact your GP" one such nurse told me – so it is in practice up to you to act on this basic rule. If you suffer an acute retention, get hurtled to the urologist immediately, unless you have made a careful prior arrangement with your GP to fix it!

I am even sorrier to have to report that there are nurses who do know what should be done for this emergency, but withhold treatment – presumably because they have really taken to heart the slogan "all men are rapists" and similar man-hating ideology. I strongly advise men to stay out of the Auckland Public Hospital emergency clinic, if suffering blockage of urine, and out of that hospital’s urology ward altogether. Even if you are recovering in a good private hospital, with a high ratio of qualified nurses, you may be left in agony for an hour while they refrain from helping you.

The practical advice therefore is: if you suffer a complete blockage, get assertive – get very assertive. You may have to insist with a force outside your previous experience. You may have to make more noise than would otherwise be tolerable in a hospital. It may take such unprecedented insistence to overcome this new, wicked refusal of help. And as you leave hospital make sure you have a clear arrangement with your doctor to get relief in the event of such a blockage.

To summarise: enlarged prostate glands can be fixed by getting on the TURPs, an operation which is itself simple & painless but can lead to severe complications which some nurses want you to suffer. So be in especially close contact with your doc!

The first item that caught my eye when I looked at the back cover of the August 98 publication from Auckland Healthcare Services Ltd was under the heading "Family Violence Damming Statistics – lets make a difference." The first ‘damming statistic’ is that 21% of New Zealand men reported physically abusing their partners in the last year. Strangely, they don’t mention what you find when you ask New Zealand women the same questions. The next statement makes it clear why: "it is estimated that 95% of partner violence is committed by men." Clearly you have to be very selective about the data you consider if you want to make these kind of ideologically inspired ‘estimates’. This kind of deliberate dissemination of misinformation does not exactly inspire confidence in the credibility of this organisation.

Zero Tolerance Campaign

Inside the newsletter, a double page spread begins by detailing the work of the Auckland Regional Zero Tolerance Campaign. The extreme ideological stance of the campaign is understandable when you consider the unrepresentative nature of the groups from which members are drawn:

women’s support agencies

violence intervention projects

women’s refuges

Safer Cities Councils

Auckland Healthcare

women’s centres

The aim of the campaign is to raise awareness of the problem of domestic violence, and to increase the capacity of the community to respond. Presumably this means still more jobs and funding to aid the overthrow of the patriarchal power structure. The end result of using public funding to spread falsehoods in this way will no doubt make the problem seem even larger than it does now, and worthy of increased public funding. The Zero Tolerance executive responsible for this particular piece of radfem propaganda is:

Jo Elvidge

Marilyn Burton

Annie Cochrane

Sarah Bartlett

Parpara Carroll

Grahame Howard

Reece Helmondollar

Ministry of Health releases Family Violence Intervention Model

This ‘best practice model’ seems to be basically a marketing tool for generating new business for the domestic violence industry. It advocates protocols for health professionals and agencies designed to uncover previously unsuspected cases. In the Jan 98 MENZ Issues we discussed the shortcomings and biases of the work on which this model is based.

The Health of Women Report

The Northern Health Funding Agency (previously North Health), has released the results of one of the most comprehensive consultations they have carried out. In hui, fono, and focus groups they listened to hundreds of Auckland women and women’s groups talk about their health needs. What a surprise, physical and sexual abuse was ranked the highest priority. I wonder when the NHFA plans to ask men about their health needs?

Network of Women’s Support Agencies

Health Promotions advisers were instrumental in helping develop the Network of Women’s Support Agencies back in 1995. It is a forum for women’s groups involved in family violence intervention. It operates to develop supportive and co-operative working relationships between groups, and makes submissions on legislation. NOWSA is supported by the Auckland Safer Community Council. There was no indication that Health Promotions plans to help set up a similar forum for men’s support agencies.

South Auckland Family Violence Prevention Network

Working from Friendship House in Manukau, Resource Co-ordinator Margaret Sinclair has set up a data base of family violence resources, and manages the network of 140 agencies and individuals working in the field. They meet on the first Thursday of each month, and unlike the North Harbour Family Violence Prevention Project meetings (which only accepts members prepared to sign their allegiance to radfem principles), everyone is welcome at the Manukau meetings.

From Abuse to Family Strength

This $320,000 Health Promotions research project, which is looking at ways to make it easier for women to separate from their abusive husbands, was described in the July 98 MENZ Issues (here).

The last six months have been taken up with ‘community consultation and liaison’, particularly by the Maori and Niuean researchers. During a fono at Health Promotion in Kingsland, some women said they felt that Pacific Island Communities are over-researched. Others raised the need for researchers to be accountable to the community, and it was seen as a high priority that researchers research within their own community. The Pakeha researchers have talked to approximately 20 women. They have discovered that some family members do not consider living with an abusive partner sufficient reason for a relationship to end. Often, women are even strongly encouraged to return to their partners and resume the relationship. Obviously, something needs to be done about these incorrect attitudes!

On the Other Hand…

Among the 30 women and 5 men at Auckland Health Promotion, there are a few people doing what we consider to be worthwhile jobs. An article by Shayne Nahu discusses his attendance at the National Foetal Alcohol Syndrome Conference in Hamilton. He suggests that there needs to be a multi-pronged approach which concentrates on support for families or individuals affected by FAS, and on preventing new cases. He says it is the leading cause of preventable intellectual disability, and that health and education professionals need to respond appropriately.

Drinking by young New Zealand women is increasing, and we have a high rate of teenage pregnancy – often alcohol related. There is NO safe level for drinking during pregnancy. Often young women may not even be aware they are pregnant for many weeks, by which time irreversible damage may be done to the foetus.

Healthy Habits for Life

A pilot healthy eating/healthy lifestyle programme is being run at Fisher and Paykel Refrigeration by Chris Cook and Kate Sladden, dieticians with Auckland Healthcare, Health Protection. The programme focuses on (gasp) men, because of their earlier mortality and higher risk factor rates compared with women. The aim is to improve the eating habits of the participants, and consequently reduce their risk factors for lifestyle diseases such as heart disease, diabetes and stroke.

To see whether this programme makes a difference, the men involved have completed a questionnaire about their food habits and knowledge, and had their weight, height, waist and blood pressure measured. This will be repeated at the end of the six month programme, and results will be compared to a control group at Auckland Meat Processing Company. The sessions will be held during working hours, and cover healthy eating, safe use of alcohol, and physical activity. Kellog (Aust) Pty Ltd and Auckland Fruit and Vegetable Corporation have donated food for prize baskets. The companies involved are to be commended. Hopefully the results will encourage more businesses to take an interest in the health of their employees.

A living hell – that’s what depression is like. A daily nightmare where there’s no relief from the symptoms of panic, anxiety, isolation and distortion. Distortion about what you think and how you think.. And pessimism, pessimism, pessimism. Will I ever get better? Will I lose my job? Will I break up with my partner? How will I ever get back on my feet again.? Unmitigating blackness and incessant anxiety. Yes there is medication. That’s held out as 50% of the answer. And yes there is counselling which is said to be the other beneficial step towards recovery.

For someone in the depths of depression, neither seems to work quickly enough. A common trend with depression is a complete blackness in the morning which lifts as the day relentlessly edges towards evening. And with that improvement as night comes, the depressive feels some lift when others around him are winding down for sleep. The intense anxiety which has wracked the depressive throughout the day denies them the comfort of any natural sleepiness. Sleeping tablets are often the only recourse.

And if the severity of the depression is so intense it requires time off work, then being home alone is cold comfort. Having company – and preferably some physical contact – are often the demands of the depressive. The nature of the illness, and its severe impact on self esteem, self confidence and get up and go, will reduce the patient to behave like a dependant child. Bouts of panic, anxiety and weeping may erupt without warning – particularly after the depressive has been for too long a walk – and over cooked things.

Men are reportedly most prone to depression and are 11 times more likely to commit suicide following relationship break-ups. And in my experience, their escape from depression is hindered by their isolation. With luck, their wives and partners will provide the backbone of what support the depressed man needs. But ironically the depressive undermines that support by attacking those nearest and dearest to him. Another depressing symptom of the illness. With irritability levels intense, the depressive criticises, irritates and nit-picks, and seldom makes the same effort with his loved ones as he does when a friend calls him on the phone.

In the most severe cases, there’s only one thing a depressive is enthusiastic about and that’s talking about his illness. Yet it is not the sort of subject you ring and chat to your best mate about. In fact because depression is slotted straight into the mental illness category, it ain’t the sort of subject you talk to too many friends about at all. Otherwise there’s a grave danger that you’ve "flipped your lid", "had a nervous breakdown", or "can’t cope". So talking to people may be restricted to the professionals – to your own psychologist or to teams from community mental health services. Both do a good job – but neither are there 24 hours a day and live the nightmare that is every minute of every day. That’s when life becomes a living hell. That’s when other options would seem easier than fighting back to health.

Yes I’m reading a book about Learned Optimism, I know my tendency to catastrophise. I know I have a predominantly negative attitude which is intensified by the depression. As the mood lifts, so does the attitude. "I will get better" I tell myself with relentless monotony.

While there are perhaps three options for "respite" or time for severely depressed sufferers, none of these are regarded as ideal by advisers. And there is no centre where those suffering from depression could go during the day – a kind of community house where feelings and experiences could be shared with others suffering the same. That would be a valuable asset, especially for men who are left out on a limb by their natural isolation….and masculine hang ups over talking about their depressive episodes.

In the Feb 1994 Nursing Times article ‘Equal rights for men’, Asfaf Fareed described how in the past men willingly took on traditional macho roles and tried to live up to certain ideals and expectations. However in today’s changed society, these macho ideals are being threatened. The social image of masculinity is constantly being challenged. Men have attempted to live up to the traditional male role while also trying to conform to present conditions. This is clearly unrealistic, and Fareed argues that this has been a factor which has caused men’s health to suffer. The feminist movement has challenged the macho male stereotype with ideas of equality, yet society still expects men to perform most of the hazardous manual work. Fareed stated that in this traditional culture men are less likely to seek medical advice or treatment as illness is seen as a threat to masculinity.

Steve Robertson’s article ‘Men’s health promotion in the UK – a hidden problem’ in the July 1995 British Journal of Nursing, pointed out that "Increasing unemployment and changes towards self employment and contractual work have meant that occupational health services – previously the only health contact for many healthy 18 – 65 years old – are no longer available to many men".

In the Nov 1995 Nursing Times; ‘Their own worst enemy’, Peter Williamson added that men use primary care services far less than women, both in frequency and absolute totals. Williamson also stated men are likely to delay seeking help when ill.

In 1996, Katharine Whitehorn claimed in the Herald that the ‘correct’ masculine attitude amongst men towards illness is to laugh it off, play it down, and not go near doctors. She cited a survey that showed sixty percent of men do not have a doctor. She stated many men refuse to endure the usual hour’s wait to see a doctor. She said that when men do ‘crash’ due to illness it is total.

Men’s health researcher Richard Fletcher says that men have difficulty discussing health problems. They have a "garage mentality", and want to "leave their bodies and come back and get them when they are fixed". He believed general practitioners needed to be educated to ask different questions of men.

Member of Parliament Ross Robertson has expressed concern that the Government is causing men to fall ill because he believes it is not politically correct to concentrate on men. He said "It’s almost don’t care about men’s issues". He cited statistics that showed prostate cancer had increased by 65% between 1982 and 1992. Prostate cancer only got 7 per cent of the money that went into researching breast cancer. Robertson pointed out that while the Government spent millions on a campaign on cervical cancer, during the same period the male-only killer went ignored. Mr Robertson said "There is a need in New Zealand right now for much higher awareness of male health issues".

Unfortunately, then Minister of Health Jenny Shipley admitted that the Government has "no specific plans to promote men’s health issues".

A study by British based Research International, described men in New Zealand as being almost apologetic about their gender. It said men believed they are portrayed in society as being mean, over aggressive, unsympathetic, and sexually threatening. It stated: "Men felt under attack by the new confidence of women, who had moved on and achieved their goals, leaving men behind". Men over 40 felt threatened by the ascending female status, men below 40 were comfortable with female confidence, but had lost their own, and men in their 20s were the most able to accept women’s confidence, but received mixed messages from the media and society about their role in the world. This study painted a picture of men feeling confused, threatened and having a lack of confidence. This must be detrimental to men’s health.

The Oxford dictionary defines exclude as to "shut or keep out (a person or group) from a place, group or privilege". I believe the statistics show the privilege of health is being kept from men. The question must be asked as to why? Why do the health statistics reflect so poorly on us? The simplistic answer is to blame men for their poor health and require them to change their traditional masculine behaviours.

I agree with Men’s Centre chairman Mark Rowley that simply insisting that men be less masculine would change little and achieve less. Blaming men for their health problems only marginalise male heath issues. But there does need to be a deeper look into masculinity to see what changes could be made to help men become healthier.

Men have allowed society to stereotype them into roles that are not consistent with good health care practices. We teach men to deny they are ill, which conforms to the traditional macho view of men. This stops men from accessing primary care, and they thus become excluded from it. While men have traditionally held positions of control within the healthcare system, they have not used this power to attain superior health care services for other men. Recent health care policy has concentrated on the needs of groups such as women, people with disabilities, and ethnic minorities. There is certainly some truth in the argument that traditional masculine attitudes have been men’s worst enemy with regard to the issue of health.

Debate among Nurses

There has been recent debate amongst nurses in the Australian Nursing Journal about men’s health issues. It started when Anthony Black’s article ‘Men’s health – why the neglect?’ was published Aug 1995. He claimed that there has been a neglect of men’s health and cited statistics to support this theory. He suggested a need for ‘Male clinics’ (along the lines of ‘Women’s clinics’) as an idea for addressing this problem. He pointed out that universities dedicate whole subjects to "health issues relating to women", but said it is rare to find courses solely relating to male issues.

In Dec 1995 this drew a response from Lorraine Haw titled ‘Men’s health makes me ill’. She said she was sick of hearing about men’s health. She claimed that most of the major policy makers, decision makers, and researchers are men. She said that statistics cited by Black showed only that men have a behavioural problem.

Colin Scott disagreed in Feb 1996 by claiming ‘Men’s health is no joke’. He pointed out to Haw that the policymakers and decision makers are not all men. He described Haw’s views towards men’s health as "twisted and warped". Scott said that the only thing making her ill was "an anti-male feminist ulcer eroding her heart and soul".

This bought a further response from Ian Sharpe in April 1996: ‘Men’s health: a patriarchal problem’, in which he stated that before we debate male health issues, we must concern ourselves with men and anger management, domestic violence, and human right abuse. He claimed that men’s bad health was a direct result of men’s thirst for power.

The statistics do show men have health issues as a group and there has been neglect of male health issues. This neglect has a lot to do with men’s traditional masculine attitudes towards their own health. However I resent Ms Haw labelling all men as having behavioural problems (would she blame all gay men with ill-health as having behavioural problems?), and Sharpe for portraying men as being unable to control their anger, women beaters, and abusive of other’s human rights. These negative stereotypes will only further marginalise men.

Director of Mensline Bruce Mackie has said the ‘women good, men bad’ message from many feminists has not helped men. He says a whole generation of boys has grown up in a sense of shame and blame about their masculinity. He feels that if you tell children they are bad, nasty, and evil, it does not take long before they become bad, nasty, and evil. He questions how the feminist messages (particularly of the 80’s) have affected the generation that grew up in this era.

In the Journal of Advanced Nursing, July 1997, Graham MacDougall’s article ‘Caring – a masculine perspective’ claimed that the traditional male/female model relied on men oppressing women. This bought the rise of the feminist movement which liberated women from the traditional roles. He said that the greatest problem of the feminist model is that it did not provide a model for the liberation of men from the traditional model. He argued that this bought a new sexism with men as the victims, and a clash between the liberated women and the traditional man.

Australian men’s health educator Dr Allan Huggins has argued that traditional western culture allows men only the narrowest choices in expressing their masculinity. He stated that the behaviours that define the Australian and New Zealand men as masculine, such as driving fast, practising unsafe sex, drinking lots of alcohol, are detrimental to health.

Rex McCann, who runs ‘Essentially Men’ courses, says that the only perceived alternative is to become a sensitive new age guy (SNAG). He stated SNAG was a parody of a man invented by women. He said men never accepted this parody and it is time that men redefined their roles in society. He said that this new definition must value strong masculine traits such as assertion, strength, and protectiveness and that these traits are indeed positive.

Clearly, to improve the health of men there is a need for men to liberate themselves from society’s traditional view of men. Men need to learn how to communicate pain in a way that retains masculinity. I feel a need for positive masculine role models along these lines. I think this is the most important factor towards creating healthy men.

McCann says the men he meets talk of powerlessness, confusion as to their identity, feeling isolated from other men, or at least a sense that their friendships with other men could be a lot better. McCann says society has to let men get beyond the traditional stereotypes. He states that men are nurturers, and men can be compassionate. Society has got to change to let these qualities come out. McCann believes ‘thou shalt not cry’ is an attitude that rings in every man’s ears.

Bruce Mackie states there is a need to inspire men to tune into other men, and become sensitive more towards other men. He too believes society must stop blaming men for all its problems. Mackie says men’s studies groups are aiming to re-establish what it means to be male. They hope to redefine masculinity so it can be in partnership with women. But women have not been invited to participate. He argues it needs to be a movement by men, for men, as women cannot tell a man what it means to be male.

Steve Biddulph, the popular Australian writer and psychologist, says change for men would only be a small step to take. He says we already have a big tradition of men being with each other. He believes men just have to start getting real with one another. "If a man’s wife leaves him, the Australian tradition is to say ‘Half your luck’ and make a joke of it". Biddulph says the only change men need to make is to ask "How are you finding it?" He also says men need to try and improve their relationships with their fathers. He claims that one third of men never speak to their dads. He argues that four generations of industrialisation have made absent fathers the social norm. Changing these two aspects of our culture, could be the best ways of improving men’s health.

Lion Red

To conclude, I would like to describe what I feel is an interesting and positive development. Lion Red Beer is a label traditionally associated the with working class men in New Zealand. Until recently they promoted themselves with ‘macho’ images loosely associated with New Zealand’s two popular male sports Rugby Union and Rugby League. Lion Red obviously felt most New Zealand men could identify with the rugby heroes that they promoted.

But 1998 bought a change in the images used. The new advertisements portray a great friend, a great father, and a great husband. They depict men with qualities of strength, loyalty, courage, commitment. Yet these men are sensitive and caring while remaining undoubtedly masculine. Realistically, most New Zealand men will never be an All Black or a Kiwi, but all men have the potential to be a great friend, father, and husband. These are positive images of what it is to be a man.

This is a healthy message even though it has come from an arguably unhealthy source. I feel it is better for men to be getting this message from this source, than not getting the message at all. It could be argued that beer is a bastion of the traditional male stereotype. This shows the message is now coming from within.

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